Skip to main content

Advertisement

SpringerLink
Log in

Predictors of residual simultaneous multiple ground-glass nodule progression after dominant lesion resection

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Objective

This study aimed to identify the predictive factors for the progression of residual simultaneous multifocal ground-glass nodules (SMGGNs) after resection of the dominant lesion.

Methods

Patients (n = 3420) with primary lung cancer who underwent lung resections at our hospital between 2006 and 2016 were screened, and the data from 82 patients who had residual SMGGNs after undergoing surgery for the dominant lesion (pathologically stage 0-IIA) were retrospectively analyzed. Clinicopathological factors that predicted the growth of residual second dominant GGNs were identified.

Results

Median total tumor and solid component sizes of the residual second dominant GGNs were 1.3 cm (interquartile range [IQR]: 0.6–2.0) and 0 cm (IQR: 0–0.7), respectively. During a median follow-up period of 54 months (IQR: 37–78 months), 35 (43%) lesions progressed. Logistic regression analysis revealed that age younger than 70 (OR: 10.54, 95% CI: 1.71–65.11), a dominant lesion with pure solid appearance (reference: GGN, OR: 18.16, 95% CI: 1.66–198.60), a second dominant GGN total size larger than 1.0 cm (OR: 12.27, 95% CI: 1.85–81.17), and a second dominant GGN solid component size larger than 0.5 cm (OR: 17.59, 95% CI: 3.58–86.47) were significant predictive factors for the progression of residual GGNs (all p values < 0.03). Based on an analysis of growth patterns, rapid growth was higher in second dominant GGNs with a part-solid appearance.

Conclusions

If the resected dominant lesion or the residual second dominant GGN exhibits high-risk factors, the second dominant GGN should be meticulously observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The participants of this study did not give written consent for their data to be shared publicly, so due to the sensitive nature of the research supporting data is not available.

Abbreviations

AUC:

Area under the curve

CEA:

Serum carcinoembryonic antigen

CI:

Confidence interval

GGO:

Ground-glass opacity

GGN:

Ground-glass nodule

HRCT:

High-resolution computed tomography

JCOG:

Japan Clinical Oncology Group

OR:

Odds ratio

ROC:

Receiver operating characteristic

SMGGN:

Simultaneous multifocal ground-glass nodule

TNM:

Tumor, node, metastasis

VDT:

Volume-doubling time

WHO:

World Health Organization

References

  1. Sobue T, Moriyama N, Kaneko M, Kusumoto M, Kobayashi T, Tsuchiya R, et al. Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. J Clin Oncol. 2002;20:911–20.

    Article  PubMed  Google Scholar 

  2. Detterbeck FC, Franklin WA, Nicholson AG, Girard N, Arenberg DA, Travis WD, et al. The IASLC lung cancer staging project: background data and proposed criteria to distinguish separate primary lung cancers from metastatic foci in patients with two lung tumors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2016; 11: 651–65.

  3. Trousse D, Barlesi F, Loundou A, Tasei AM, Doddoli C, Giudicelli R, et al. Synchronous multiple primary lung cancer: an increasing clinical occurrence requiring multidisciplinary management. J Thorac Cardiovasc Surg. 2007;133:1193–200.

    Article  PubMed  Google Scholar 

  4. Chang YL, Wu CT, Lee YC. Surgical treatment of synchronous multiple primary lung cancers: experience of 92 patients. J Thorac Cardiovasc Surg. 2007;134:630–7.

    Article  PubMed  Google Scholar 

  5. De Leyn P, Moons J, Vansteenkiste J, Verbeken E, Van Raemdonck D, Nafteux P, et al. Survival after resection of synchronous bilateral lung cancer. Eur J Cardiothorac Surg. 2008;34:1215–22.

    Article  PubMed  Google Scholar 

  6. Finley DJ, Yoshizawa A, Travis W, Zhou Q, Seshan VE, Bains MS, et al. Predictors of outcomes after surgical treatment of synchronous primary lung cancers. J Thorac Oncol. 2010;5:197–205.

    Article  PubMed  Google Scholar 

  7. Gu B, Burt BM, Merritt RE, Stephanie S, Nair V, Hoang CD, et al. A dominant adenocarcinoma with multifocal ground glass lesions does not behave as advanced disease. Ann Thorac Surg. 2013;96:411–8.

    Article  PubMed  Google Scholar 

  8. Shintani Y, Okami J, Ito H, Ohtsuka T, Toyooka S, Mori T, et al. Clinical features and outcomes of patients with stage I multiple primary lung cancers. Cancer Sci. 2021;112:1924–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Shimada Y, Saji H, Otani K, Maehara S, Maeda J, Yoshida K, et al. Survival of a surgical series of lung cancer patients with synchronous multiple ground-glass opacities, and the management of their residual lesions. Lung Cancer. 2015;88:174–80.

    Article  PubMed  Google Scholar 

  10. Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Oncological characteristics of radiological invasive adenocarcinoma with additional ground-glass nodules on initial thin-section computed tomography: comparison with solitary invasive adenocarcinoma. J Thorac Oncol. 2016;11:729–36.

    Article  PubMed  Google Scholar 

  11. Hattori A, Takamochi K, Oh S, Suzuki K. Prognostic classification of multiple primary lung cancers based on a ground-glass opacity component. Ann Thorac Surg. 2020;109:420–7.

    Article  PubMed  Google Scholar 

  12. Gao RW, Berry MF, Kunder CA, Khuong AA, Wakelee H, Neal JW, et al. Survival and risk factors for progression after resection of the dominant tumor in multifocal, lepidic-type pulmonary adenocarcinoma. J Thorac Cardiovasc Surg. 2017;154:2092-2099.e2.

    Article  PubMed  Google Scholar 

  13. Suzuki K. Whack-a-mole strategy for multifocal ground glass opacities of the lung. J Thorac Dis. 2017;9:S201–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the fleischner society 2017. Radiology. 2017;284:228–43.

    Article  PubMed  Google Scholar 

  15. Aokage K, Suzuki K, Saji H, Wakabayashi M, Kataoka T, Sekino Y, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): a multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med. 2023;11:540–9.

    Article  CAS  PubMed  Google Scholar 

  16. Suzuki K, Watanabe S-I, Wakabayashi M, Saji H, Aokage K, Moriya Y, et al. A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer. J Thorac Cardiovasc Surg. 2022;163:289-301.e2.

    Article  PubMed  Google Scholar 

  17. Yoshino I, Moriya Y, Suzuki K, Wakabayashi M, Saji H, Aokage K, et al. Long-term outcome of patients with peripheral ground glass opacity dominant lung cancer after sublobar resections. J Thorac Cardiovasc Surg. 2023;10:8.

    Google Scholar 

  18. Schwartz M. A biomathematical approach to clinical tumor growth. Cancer. 1961;14:1272–94.

    Article  CAS  PubMed  Google Scholar 

  19. Jiang L, He J, Shi X, Shen J, Liang W, Yang C, et al. Prognosis of synchronous and metachronous multiple primary lung cancers: systematic review and meta-analysis. Lung Cancer. 2015;87:303–10.

    Article  PubMed  Google Scholar 

  20. Yu YC, Hsu PK, Yeh YC, Huang CS, Hsieh CC, Chou TY, et al. Surgical results of synchronous multiple primary lung cancers: similar to the stage-matched solitary primary lung cancers? Ann Thorac Surg. 2013;96:1966–74.

    Article  PubMed  Google Scholar 

  21. Chen K, Chen W, Cai J, Yang F, Lou F, Wang X, et al. Favorable prognosis and high discrepancy of genetic features in surgical patients with multiple primary lung cancers. J Thorac Cardiovasc Surg. 2018;155:371-379.e1.

    Article  PubMed  Google Scholar 

  22. Wu C, Zhao C, Yang Y, He Y, Hou L, Li X, et al. High discrepancy of driver mutations in patients with NSCLC and synchronous multiple lung ground-glass nodules. J Thorac Oncol. 2015;10:778–83.

    Article  CAS  PubMed  Google Scholar 

  23. Chung JH, Choe G, Jheon S, Sung SW, Kim TJ, Lee KW, et al. Epidermal growth factor receptor mutation and pathologic-radiologic correlation between multiple lung nodules with ground-glass opacity differentiates multicentric origin from intrapulmonary spread. J Thorac Oncol. 2009;4:1490–5.

    Article  PubMed  Google Scholar 

  24. Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2017;154:2102-2110.e1.

    Article  PubMed  Google Scholar 

  25. Aokage K, Miyoshi T, Ishii G, Kusumoto M, Nomura S, Katsumata S, et al. Influence of ground glass opacity and the corresponding pathological findings on survival in patients with clinical stage i non-small cell lung cancer. J Thorac Oncol. 2017;13:533.

    Article  PubMed  Google Scholar 

  26. Hattori A, Suzuki K, Takamochi K, Wakabayashi M, Aokage K, Saji H, et al. Prognostic impact of a ground-glass opacity component in clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2021;161:1469–80.

    Article  PubMed  Google Scholar 

  27. Kakinuma R, Noguchi M, Ashizawa K, Kuriyama K, Maeshima AM, Koizumi N, et al. Natural history of pulmonary subsolid nodules: A prospective multicenter study. J Thorac Oncol. 2016;11:1012–28.

    Article  PubMed  Google Scholar 

  28. Hiramatsu M, Inagaki T, Inagaki T, Matsui Y, Satoh Y, Okumura S, et al. Pulmonary ground-glass opacity (GGO) lesions-large size and a history of lung cancer are risk factors for growth. J Thorac Oncol. 2008;3:1245–50.

    Article  PubMed  Google Scholar 

  29. Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399:1607–17.

    Article  CAS  PubMed  Google Scholar 

  30. Miyoshi T, Aokage K, Wakabayashi M, Shimoyama R, Kataoka T, Fukuda H, et al. Prospective evaluation of watchful waiting for early-stage lung cancer with ground-glass opacity: A single-arm confirmatory multicenter study: Japan Clinical Oncology Group study JCOG1906 (EVERGREEN study). Jpn J Clin Oncol. 2021;51:1330–3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Takashi Sakai for useful discussions and for carefully proofreading the manuscript.

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Tomohiro Miyoshi, Kenta Tane, Joji Samejima, Keiju Aokage & Masahiro Tsuboi

Authors
  1. Tomohiro Miyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenta Tane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joji Samejima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keiju Aokage
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masahiro Tsuboi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomohiro Miyoshi.

Ethics declarations

Conflict of interest

This research was not supported by any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyoshi, T., Tane, K., Samejima, J. et al. Predictors of residual simultaneous multiple ground-glass nodule progression after dominant lesion resection. Gen Thorac Cardiovasc Surg 72, 183–191 (2024). https://doi.org/10.1007/s11748-023-01968-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-023-01968-x

Keywords

Search

Navigation